COF COF Diabetic & Therapeutic Footwear 4 — Questions and Answers
Question 1: Under the Medicare Therapeutic Shoe Bill (Section 4572), how many pairs of depth-inlay shoes per calendar year is a qualifying diabetic patient entitled to?
- One pair (Correct answer)
- Two pairs
- Three pairs
- Four pairs
Correct answer: One pair
Medicare covers one pair of depth-inlay shoes (or one pair of custom-molded shoes) per calendar year for qualifying diabetic beneficiaries.
Question 2: Which Medicare documentation requirement must a certifying physician complete before a patient can receive therapeutic footwear?
- Certificate of Medical Necessity (CMN) (Correct answer)
- Prior Authorization Form
- Durable Medical Equipment Order
- Podiatric Referral Letter
Correct answer: Certificate of Medical Necessity (CMN)
A Certificate of Medical Necessity signed by the certifying physician is required to qualify the patient for the Medicare therapeutic shoe benefit.
Question 3: A patient with diabetes presents with a healed plantar ulcer at the first metatarsal head. Which shoe modification best offloads this high-pressure area?
- Metatarsal bar applied externally to the outsole (Correct answer)
- Lateral wedge added to the midsole
- Extended steel shank
- Thomas heel modification
Correct answer: Metatarsal bar applied externally to the outsole
An external metatarsal bar transfers pressure proximal to the metatarsal heads, directly offloading a healed plantar ulcer at that site.
Question 4: When fitting diabetic footwear, what minimum toe box depth is recommended to prevent dorsal toe pressure in patients with hammertoes?
- At least 1/2 inch of clearance above the longest toe (Correct answer)
- Exactly flush fit with no clearance
- At least 1 inch clearance above the longest toe
- Clearance only at the great toe
Correct answer: At least 1/2 inch of clearance above the longest toe
A minimum of 1/2 inch (approximately 1.25 cm) of vertical clearance above the longest toe prevents dorsal pressure on hammertoe deformities.
Question 5: Which insole material is most appropriate as the top cover for a diabetic patient with peripheral neuropathy to minimize shear forces?
- Plastazote (closed-cell polyethylene foam) (Correct answer)
- Cork
- Leather
- Rigid carbon fiber
Correct answer: Plastazote (closed-cell polyethylene foam)
Plastazote is preferred as a top cover in diabetic insoles because it molds to foot contours and reduces shear and pressure in insensate feet.
Question 6: A diabetic patient who also has significant midfoot collapse (Charcot foot, stage III) would MOST benefit from which footwear approach?
- Custom-molded shoes with a rigid rocker sole (Correct answer)
- Standard depth-inlay shoes with prefabricated inserts
- Athletic shoes with extra-depth toe box only
- Open-toed sandals with arch support
Correct answer: Custom-molded shoes with a rigid rocker sole
Charcot foot with midfoot collapse requires custom-molded shoes to accommodate the deformity and a rigid rocker sole to redistribute plantar pressures.
Question 7: Under Medicare guidelines, how many pairs of custom-fabricated inserts (not prefabricated) are covered per year when the patient receives depth-inlay shoes?
- Three pairs (Correct answer)
- One pair
- Two pairs
- Four pairs
Correct answer: Three pairs
Medicare allows up to three pairs of custom-fabricated inserts per calendar year when the patient receives the depth-inlay shoe benefit.
COF COF Diabetic & Therapeutic Footwear 4
Under the Medicare Therapeutic Shoe Bill (Section 4572), how many pairs of depth-inlay shoes per calendar year is a qualifying diabetic patient entitled to?